December 2017

NAELA Fights to Save the Medical Expense Deduction

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NAELA Advocacy Update

December 2017

NAELA Fights to Save the Medical Expense Deduction

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At the end of September, Republicans outlined their tax reform proposal. It called for eliminating all itemized deductions except the mortgage interest and charity deductions. This raised immediate concerns at NAELA that the Medical Expense Deduction could get eliminated.


In early November, the House released its tax package. It ended the medical expense deduction. NAELA was prepared and able to respond quickly, focusing on the potential devastating impact on individuals in need of long-term services and supports.


NAELA also worked with AARP to build a loose coalition of supporters of the deduction that grew from less than a handful of organizations to more than 60, including the American Cancer Society, the March of Dimes, and LeadingAge.


Thanks to these coalition efforts, the Senate tax package not only retains the medical expense deduction, but temporarily expands it. Under the Senate bill, for 2018-19, there is a threshold to 7.5 percent of AGI.


Negotiations starting this week between the House and Senate will be crucial to determining the fate of the deduction. NAELA continues to work with AARP and other organizations in support of the Senate provisions. Contact your member of Congress today and urge them to take up the Senate's Medical Expense Deduction provisions in the final tax bill.

Changes Likely Coming With the Tax Bill, But What?

With the Senate and House meeting to resolve their different bills, a comprehensive change to the tax code looks likely. Beyond the medical expense deduction, a number of policies could impact your clients and your practice, such as:

  • Ending personal exemptions;
  • Improvements to ABLE Accounts; and
  • Raising the thresholds for the estate tax.

Stay tuned for NAELA education, if a tax bill becomes law.

Key Democrats Raise Alarm Over Iowa Waiver


The swiftness of CMS approving Iowa’s request to repeal three-month retroactive coverage of Medicaid raised alarms among advocates. NAELA previously teamed up with aging and disability organizations opposing the move.


Ranking-members Frank Pallone (D-NJ) of the Energy and Commerce Committee and Ron Wyden (D-OR) of the Senate Finance Committee have responded to CMS Administrator Verma citing their concerns.


“Instead of seeking to test new or innovative delivery system models that improve access to care, this amendment would threaten the medical and financial wellbeing of thousands of individuals, including seniors and individuals with disabilities who rely on Medicaid for essential long-term care such as nursing and home-based care,” Pallone and Wyden said.


Watch NAELA’s webinar on 1115 waivers to learn more about the risks associated with their abuse and what you can do about it.

Major Health Measures Have Expired - Risks Remain In Final Package

A number of important health policies expired in October that require Congress to work on a bipartisan basis to move these forward. These include:

  • The Children’s Health Insurance Program (CHIP), which provides health coverage to children in families with incomes that are modest but too high to qualify for Medicaid.
  • Medicare Part B therapy caps exceptions process. For 2017, the cap amount is $1,980 for physical and speech therapy combined and $1,980 for occupational therapy.
  • Delay of Ahlborn repeal, which would give states the ability to recover Medicaid costs from a beneficiary's full personal injury settlement.

NAELA supported passage of key items and remains vigilant against potentially harmful “pay-fors” to offset the cost of these provisions.

Bipartisan Subcommittee Leaders Release Rep Payee Reform Bill

Chairman Sam Johnson and Ranking-member John Larson of the House Ways and Means Subcommittee on Social Security introduced legislation to improve the Social Security Administration’s Rep Payee system. The Strengthening Protections for Social Security Beneficiaries Act of 2017 (H.R. 4547) would increase the number of performance reviews of payees; eliminate the requirement to file an annual payee accounting form for parents who live with their children and for spouses; and allow beneficiaries to designate their preferred payee in advance of actually needing one. Early this year, NAELA participated in a Consortium for Citizens with Disabilities (CCD) working group to provide recommendations to Congress.

Congressional Support Grows to Make HCBS a Civil Right

Child in Wheelchair Sitting Next to Parent

The Disability Integration Act, which guarantees home and community-based services (HCBS) as a civil right, continues to gain support in Congress. The Senate legislation introduced by Minority Leader Schumer has 15 co-sponsors; the House legislation introduced by Rep. Jim Sensenbrenner (R-WI) has 68. Visit the Disability Integration Act website to learn more.

NAELA Examines Issue of IRA Assignability to SNTs

Today, many individuals who require first-party special needs trusts must liquidate their tax-deferred retirement account in order to qualify for Medicaid LTSS. Unfortunately, this means they get hit with a big up-front tax bill. This quarter, NAELA has discussed the issue with several House offices regarding legislation to address the issue. If you have seen this issue in practice, please share your stories.

Please share any of this information with your clients and networks! Post to Facebook/Twitter/Google+ too! Thank you for your support.

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